15 Important Facts About Transgenders And Sex Reassignment Surgery

Kaleigh Maxwell September 16th 2016 Health

Through outlets including social media, magazines, movies, television, and music, the term "transgender" has become more and more familiar. Stories of transgender celebrities such as Caitlyn Jenner and Laverne Cox have brought attention to this unfamiliar topic. Today, most will agree that the transgender community exhibits incredible strength when facing diversity; however, they will not be able to state how or why. It is important to educate yourself on the entirety of the subject in order to respect and support these individuals.

1. Statistics

The correct number of individuals who identify as transgenders is not known. There is extremely limited evidence stating how many individuals identify as transgender, mainly because the term “transgender” is different to every individual. Due to this challenging reality, gathering definite statistics regarding the transgender community is a very difficult feat. The very limited amount of information we do have today comes from small surveys or case studies. For example, the National Center for Transgender Equality and the National Gay and Lesbian Task Force in 2008, which is still the largest survey to-date on the topic. In their published survey titled “Injustice at Every Turn”, they reported that 63% of the 6,450 transgender individuals that they surveyed have been discriminated against in several serious ways (transequality.org). Even though this is still the largest survey of the transgender population, specialists have begun to gather information from smaller surveys in order to make educated assessments and conclusions regarding the transgender population.

With the information from three surveys conducted in both Massachusetts and California, an LGBT demographer at UCLA’s School of Law (Gary Gates) came up with the most recent estimation. According to Gates, there are about 700,000 Americans who identify as transgender - which is about 0.3% of adults. Even with this information, we are still yet to know the exact amount of the transgender population undergo any type of medical procedures in order to alter their bodies. The best estimate today comes from The Encyclopedia of Surgery, which says "the number of gender reassignment procedures conducted in the United States each year is estimated at between 100 and 500. The number worldwide is estimated to be two to five times larger.”Even though this is a trustworthy source, this number is often challenged by other researchers, since several specialized surgeons responded by stating that they perform a couple hundred sex reassignment surgeries by themselves each year. Looking at a larger spectrum, worldwide surveys have lead to the estimation that about 2% - 5% of the entire world identifies as transgender (www.transgenderlaw.org). Even though researchers are still unable to determine the size of the transgender population with complete certainty, it is said that this gap of knowledge is closing slowly - but surely.

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2. A Quick Timeline

While it is very interesting to learn about all of the facts and details of what it means to identify as a transgender individual, it is always interesting to learn about how it all began. Although there are a few records of Sex Reassignment Surgeries taking place in the early 1900s, the idea of using medical resources to transition gender wasn’t well known until the middle of the 20th century. In the early 1950s, famous entertainer and author Christine Jorgensen made headlines for undergoing a medical operation to change sexes. According to www.biolgraphy.com, "Jorgensen’s very public transformation from a man to a woman launched a national discussion about gender identity, and her story stood as an inspiring example to others that suffered from that same feeling about being trapped in the wrong body, or gender dysphoria as it is also called.” The next newsworthy event occurred in 1964, when famous philanthropist - Reed Erickson - donated millions of dollars to promote awareness and equality for the transgender and gay population. Rumor has it that the empowerment from the Erickson Educational Foundation brought about the Campton Cafeteria Riots (1966) and the Stonewall Riots (1969). Some believe that these riots - the first time transwomen took a stand - began the modern day LGBT and transgender movements.

Since then, there have been an incredible amount of historic events in the transgender community. Within the past 50 years, transgender individuals have gained attention through politics, the courtroom, entertainment, athletics, and many other popular areas. While most of the historical events related to this topic, there are some awful events as well. The first Transgender Day of Remembrance (TDOR) took place in 1999, a year after the murder of Rita Hester in Massachusetts. Since then, this yearly day of honor remembers those who have been affected by the brutal discrimination against the LGBT and transgender community. To find out more about various related events, or for a complete timeline, visit glaad.org/transgender.

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3. Transgender vs. Transsexual

Research shows that most individuals are most familiar with the term “transgender”, and automatically associate all similar ideas, beliefs, and details - which is not the case! To start, transgender is considered an “umbrella term” for individuals dealing with gender identity issues. There are numerous categories of individuals that fall under the term transgender, including androgynous, multigendered, gender nonconforming, third gender, two-spirit people, genderqueer, cross-dressers, and drag-queens. While a some of those words may sound familiar, the qualities and characteristics that define each category vary among individuals. Transgenders deal with challenges brought on from their own gender expression due to the socially constructed roles and stereotypes of being male or female. In other words, transgender describes people who identify themselves as the opposite gender displayed on their birth certificate. These individuals feel more comfortable living their daily lives as their chosen gender; however, transgender individuals have not taken drastic measures to medically alter their bodies.

While nearly one million Americans identify as transgenders, the population that identifies as transsexuals is significantly lower. This may sound confusing, but this is due to the fact that transsexual is just one of the categories within the transgender population. While transsexuals also disagree with their anatomical gender, they medically alter (or desperately wish to alter) their gender in order to realign their features in accordance with their desired gender. Such changes may include hormone therapy, sex-reassignment surgery, or any other changes that biologically alter one’s sex. For most transgenders, continued struggle with gender expression often leads to a medical diagnose of depression, anxiety, panic, or other psychological disorders; however, individuals who identify as transsexual are typically medically diagnosed as “Gender Dysphoric.” Unlike psychotherapy sessions to help one deal with the challenges of being transgender, transsexuals believe that they will only truly be content when their biological gender and psychological gender match.

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4. The Different Categories of Transgender

As previously stated: there are numerous categories of individuals that fall under the term transgender. When discussing any sort of transgender-related vocabulary, the first term to know is “gender variance.” Also referred to as gender non-conformity, this word refers to any behavior and interest that "fits outside of what we consider ‘normal’ for a child or adult’s assigned biological sex” (www. gender diversity.org). Only used when discussing these behaviors/actions in the long term, gender variance is a term that acts as the basis for the transgender community. Most individuals exhibiting such feelings normally just identify themselves as transgender; however, some indigenous North Americans referred to gender variant individuals in their population as “Two-Spirted.” This term is unique to this community because they believe these individuals have been given a spiritual role with both male and female spirits inside of them. While usually referred to as Continuing on with related vocabulary, one may identify as “androgynous”. A term that has known to apply to plants or human sexuality, androgyny is the expression of both masculine and feminine characteristics. While many identities like androgynous is defined by one gender or another, there are some individuals who identify with a “third gender”. Known as a variety of the genderqueer identities, third gender (also known as polygender” is a mix of male and female - otherwise considering yourself “genderless."

Knowing the technical three genders recognized in the transgender community, some people shift between all three of these. Recognized as being “multigendered” or “trigendered," one may identify as one of these three genders or even a mix of two genders (gender fluid) depending on the situation or their mood. All of these gender identities fall under what is known as “genderqueer”, which differs from transgender. If an individual’s sex is does not match their gender (either male or female), then they would identify as transgender; however, individuals who identify as genderqueer do experience these conflicting feelings also. The primary difference between these two terms is that genderqueer individuals don’t only identify as one gender or another and often describe feelings of gender overlap - but are known to challenge the entire idea of only two genders. Genderqueer people do not yearn to medically alter their body, but rather decide to identify themselves individually as whichever gender they may choose - if they even choose a gender.

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5. Gender Identity vs. Sexual Orientation

Either continuously overlooked, not understood, or even ignored, there is a an extremely significant difference between gender identity and sexual orientation. In addition, both of these terms are key to understanding the thoughts of a transgender individual. Any feeling or internal, personal sense of being either man or woman is known as gender identity. On the other hand, sexual orientation describes the physical, romantic, and/or emotional attraction a person feels to another (feelings are enduring - not a one time attraction). In simpler terms: gender identity refers to how you view yourself and sexual orientation refers to who you are attracted to/fall in love with.

Trying to change either an individual's gender identity and sexual orientation is not possible. In addition, these characteristics are independent of each other, and knowing one does not determine the other. Just like everyone else, transgender people have a sexual orientation - whether it is straight, gay, or bisexual. In addition, a term that is often confused with gender identity and sexual orientation is "gender expression." Unlike the terms previously explained that related to internal feels, gender expression is based on external factors expressed by an individual. These external factors include anything that fits in with societal conceptions, expectations, and stereotypes of each gender.

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6. Sex vs. Gender

While most do not know - or even think about - the differences between an individual’s sex and gender, there are several identifying qualities that separate the two terms. According to Medilexicon's medical dictionary, sex is "The biologic character or quality that distinguishes male and female from one another as expressed by analysis of the person's gonadal, morphologic (internal and external), chromosomal, and hormonal characteristics.” In simpler terms, sex is biologically assigned to them at birth according to several biological classifications. An individual is assigned either a male or a female based on several anatomical distinctions involving chromosome distribution, hormone prevalence, and physical attributes, determined during the mother’s pregnancy. Another way to look at this term is by identifying “sex” with the natural and biological facts that associate with either gender. For example, MedicalNewsToday.com provides example characteristics related to sex: "Females have a vagina, men don’t. Males have a penis, women don’t. Male newborns tend to weigh more than female newborns. Females can breastfeed their babies, males can’t. Males have deeper voices than females. Females can get pregnant, males can’t. Males have testicles and females have ovaries”

One important idea to understand regarding the differences between sex and gender is that the defining characteristics of sex do not differ among race, religion, or defining characteristics relating to gender may. Contrary to sex, Medilexicon’s medical dictionary defines gender as "The category to which an individual is assigned by self or others, on the basis of sex.”Gender is an adapted/learned significance of the expected behavior of both male and female individuals. In other words, the gender of an individual is determined by predetermined stereotypes associated with being “masculine” or “feminine.” Such stereotypes that define gender include: "Women tend to do more of the housework than their spouses do. A higher percentage of US doctors are women, compared to Egypt. Nursing is often seen as a woman's job, although many men enter the profession. In some countries women have to cover their heads when they go outside the house. 120 years ago women were not allowed to vote in elections” (MedicalNewsToday.com). These stereotypes have been socially constructed throughout history, and often make individuals struggling with gender identity afraid to explain their feelings or behave according to what they desire.

7. Gay? Straight? Bisexual?

One of the biggest questions regarding transgenders is how they define their sexual orientation. Previously discussed, sexual orientation refers to who an individual is attracted to physically, emotionally, and sexually. While this term is easy to understand, it is often confusing how one's sexual orientation is defined before and after a change in gender. In order to be politically correct, sexual orientation can only be identified by the person him/herself, whether or not they have undergone any type of hormone therapy or surgery. For example, a man who transitions (lives solely as a female) and is only attracted to men would typically be considered a straight woman - according to research. This idea is difficult to understand and support for most people. While some may support gay marriage or gender equality, the idea of "playing God" and altering your body makes supporting the sexual orientation of transgender individuals a sensitive topic.

Everyone knows the infamous acronym "LGBT," in which the first three letters refer to sexual orientation - (L)esbian, (G)ay, and (B)isexual. Due to the fact that the transgender community is commonly lumped into this category, most assume that the "T" is often assumed to stand for (T)ransgender); however, the “T" refers to gender identity of the entire community (male, female, both, neither). An online blog entitled “Transgender Mental Health” lays out several ways to distinguish between the transgender and gay communities in a way that doesn’t involve religious predjudices. A few of these differences include statements like: "Gay and Lesbian are variants of sexuality, whereas transgendered individuals have variants of gender.” Another difference is that transgender individuals employ medical services (surgery/hormone therapy) in a much bigger way than members of the LGBT community. Most importantly, author A.P. Kaplan states "The sexuality of a Transgendered Individual might be “straight”. If a transman (female-to-male) is attracted to women, then he’s straight, if a transwoman (male-to-female) is attracted to men, then she’s straight.” This statement is unanimous with the majority of opinions collected via medical research (as discussed above). In order to be respectful of the transgender community, it is important to avoid clumping trans individuals with the LGBT community, since sexual orientation is unique to every individual.

8. Gender Dysphoria

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), individuals are diagnosed with gender dysphoria when “their gender at birth is contrary to the one they identify with will be diagnosed with gender dysphoria.” In other words, a patient believes that his/her anatomical body does not match the gender that the individual desires to live and be accepted as. If an individual experiences these symptoms negatively impact their daily routine for more than six months, a psychiatrist has enough information to diagnose them as gender dysphoric. According to DSM-5, gender dysphoria is the correct term for what has been previously been known as “gender identity disorder.” It may be a surprise to some that there is in fact more than one way that gender dysphoria can be expressed. DSM-5 explains the variety of ways which include "strong desires to be treated as the other gender or to be rid of one’s sex characteristics, or a strong conviction that one has feelings and reactions typical of the other gender.”

This can be a controversial diagnosis because there is a constant disagreement between whether or not an questioning biological gender is considered a mental disorder; however, DSM-5 clearly states in its literature “It is important to note that gender nonconformity is not in itself a mental disorder.” DSM-5 is the American Psychiatric Association’s (APA) device used for classifying and diagnosing mental disorders and how people are viewed/view themselves. In fact, DSM-5 has established itself as a non-judgemental classification tool that avoids stereotypes and stigmas, in order to ensure every patient receives proper treatment and help from insurance. Although some may believe that identifying feelings associated with being a part of the transgender community as a diagnosis, it ensures "treatment access for individuals who continue to undergo hormone therapy, related surgery, or psychotherapy or counseling to support their gender transition” (DSM-5). In addition, the updated literature of DSM-5 ensures treatment for individuals who are already live as the opposite (desired) gender full-time, even if their gender change has not been legally sanctioned prior to the diagnosis. They believe that with the an identifiable term/diagnostic name such as gender dysphoria, individuals suffering from its symptoms with not only receive proper treatment, but will not be discriminated against in any social, occupational, or legal area. In fact, DSM-5 has explained their reasoning behind identifying gender dysphoria and for their future plans to provide it with its own chapter.

9. Referral Protocol

In order to undergo SRS, one must meet ALL of the requirements originally proposed by Dr. Harry Benjamin. These specifications are not established as law; however, are strictly followed in the medical community. Reputable and trustworthy sex reassignment surgeons will only perform surgeries if there is sufficient proof that the individual seeking the operation meets all of these specifications. Cases have been recorded in which individuals sought out specialists to perform SRS, but after further examination of the patient’s mental state, the doctor would not perform the operation. The requirements for an SRS patient were originally established with the knowledge of how difficult the operation is on both the body and mind, rather than to make the process as difficult as possible (which is believed by some). When a candidate fulfills all of the qualifications, they will undergo an HIV test in the office and be interviewed by the surgeon him/herself, allowing the doctor to personally evaluate and understand the patient’s mental and emotional state of mind (but only if the HIV test is negative).

In order to even be considered a potential candidate for SRS, the following information needs to be provided for the sex reassignment surgeon:

1. Live for at least one year full-time in the new gender role (called Real Life Training or RLT)

2. Engage in hormone therapy for at least one year (which can be simultaneous with the full-time experience)

3. Gain the recommendation of a psychologist or therapist after an appropriate series of sessions.

4.Gain a recommendation of a psychiatrist that surgery is not contrary to the mental health of the patient.

Most patients who undergo this procedure have been struggling with gender identity most -if not all - of their life. Although surgeries are only performed on patients who meet all of the qualifications above, it is still possible for a patient to regret undergoing the operation if their beliefs and identity of their gender should change. If this rare situation does occur, medical professionals highly advise against reversing any previous sex reassignment surgeries, as it would be extremely risky for the patients physical and mental health. Instead, medical professionals make a point of stating that even if an individual undergoes SRS, they always have the option of living as the original role since it is easy to avoid exposing one’s genitals in public. If a patient does feel a deep need to live as their original role, the patient should immediately and continuously seek counseling to explore other options and resources for support.

10. The Basics Of Sex Reassignment Surgery

While the majority of the transgender community do not undergo surgery, most - if not all - transsexuals surgery in order to change their biological sex. This procedure has been previously referred to as “Gender Reassignment Surgery”, but is now known as “Sex Reassignment Surgery” (SRS) and is performed by a limited amount of surgeons. Research shows that there are two main reasons a surgeon might perform such an operation. Surgeons report that either a newborn experiences intersex deformities and it is necessary to assign a gender, or an individual has been diagnosed with Gender Dysphoria suffering from such a strong dissonance between their mind and body that they desire to be surgically altered. In order to undergo Sex Reassignment Surgery, the patient must sign a waiver acknowledging all of the risks involved. With even the most experienced surgeons, always be aware of the risks of infection, bleeding, the possibility for follow-up operations, and very rarely - death.

Although SRS is now recognized and covered by most major insurance companies, the healthcare system does not seem to favor this operation. This accusation has been made by many transsexual individuals who face difficulty while choosing - or even finding - a surgeon. According to an online article posted by The Bilerico Project, there is an extremely small amount of surgeons who perform this operation because there is "a lack of access, knowledge, training, experience, and inter-disciplinary collaboration in the medical community.” Most surgeons who perform this operation have specialized training in urology, gynecology, or plastic and reconstructive surgery; however, there are no doctors who are certified to perform this operation. Unlike students studying to become cardiothoracic or neurological surgeons, there are very few - if any - reliable programs, internship opportunities, residences, or courses offered that train surgeons for SRS. Even though the amount of surgeons performing SRS is gradually increasing, their only option for education is to find and learn from surgeons who are currently performing the surgery.

11. Under the Knife

IMPORTANT NOTE: This page contains graphic details regarding the SRS procedure itself which may be very disturbing to some readers.

The Encyclopedia of Surgery defines Sex Reassignment Surgery (SRS) as "a procedure that changes genital organs from one gender to another.” For individuals diagnosed with “Gender Dysphoria” and who desperately want their body to match the gender they identify with, surgery is the only option that will alter external genitalia. This operation is also known as Vaginoplasty, and is also performed on females in order to reconstruct the vaginal canal and attached mucous membrane. While this procedure is fairly common for women (especially after child-birth), transforming the male external genitalia to match that of a female is much more than a simple reconstruction. Simply put, the surgery begins by removing the testes from the scrotum, followed by the removal of the penis. This process involves shortening the urethra and using the excess skin to create the vagina and external genitalia (labia). While this procedure is normally very successful, the most common complication is narrowing of the new vagina, which is corrected by dilation or using part of the colon to reconstruct the vagina.

Regardless of all factors affecting an individual or surgeon, research favors “Male to Female Transition” (MTF) because it is much simpler than "Female to Male Transition” (FTM). The successful completion of changing from female to male involves several surgeries prior to the transformation the external genitalia. In addition to undergoing a hysterectomy to remove the uterus and an oophorectomy to remove the ovaries, it is typical for patients to undergo breast-reduction surgery as well. The primary surgery affecting the external genitalia is not as successful as the previously explained vaginoplasty because FTM requires the creation of a functional penis from one of two areas of preexisting tissues. Depending on the surgeons preference or prior training, they will either form the penis from the clitoris which has been enlarged using androgenic hormones (Metoidioplasty) or rely on tissue grants from the stomach, thigh, arm - then adding an erectile prosthetic (Phalloplasty). In addition, the the urethra is rerouted to allow urination and the new scrotum formed from uniting the labia major holds prosthetic testicles. The most common problem experienced by patients who undergo this surgery is dysfunction of the penis due to the numerous factors contributing to the new penis.

12. The Recovery Process

With such a complicated and intricate procedure, most would assume that recovering would be a grueling experience; however, SRS post-op is not as difficult as one may expect. According to the Encyclopedia of Surgeries, the patient will remain in the hospital and immobilized for seven to eight days after the operation. During this time, the only real pain during recovery occurs when the patient uses altered muscles when coughing, sneezing, or laughing. With such an intense surgery – both physically and emotionally – it is normal for a patient to be severely weak (needing assistance to even roll over), and drift in and out of sleep immediately following the procedure. At some point during the remaining recovery week, a patient will need both a catheter for urinary purposes, and often also need an enema in order to flush out the digestive system. Even though it is necessary to receive immediate post op hospital care, research proves that the body is incredibly resilient and strong. The area operated on will be sore for more than a month, feelings of sexual sensation can return as soon as two weeks, one can engage in sexual intercourse only six weeks post-operation, and most patients return to work only two to three weeks after surgery.

If you or a loved one is considering undergoing SRS, make absolute sure that you are aware of and understand all potential risks the patient faces while recovering and after surgery. While it is important to understand the physical aspects of the recovery process, it is equally important to be aware of the potential mental difficulties SRS can place on a patient. Although their ability to work will not be diminished, a patient needs social and emotional support following their big change. Studies show that help from the patient’s family (rather than hired assistance) is much more effective, helpful, and comforting as one begins to readjust to their new body and lifestyle. If the patient was at all socially or emotionally unstable prior to the operation, over the age of 30, or do not possess the ideal body build for their new gender, they are at a higher risk for post-operation complications, and it is extremely important to have additional support and assistance. While all of this is very important information, Sex Reassignment Surgery will only be successful if recovery is accompanied with regular therapy and counseling, hormone therapy, and support.

13. Hormone Therapy

The first step in the process for living as the opposite gender is hormone therapy. While psychological therapy and counseling sessions precede this decision, hormone therapy begins the process of changing your gender anatomically. Hormones have the potential to significantly impact both the body, and thus is considered a drug. In the same way as any drug or medication, it is extremely important to seek professional help in order to establish treatment that provides the correct dosage for your body. If a patient receives prescriptions supplying them with an amount of hormones their body can’t tolerate, it can create serious health risks like blood clots, cancer, osteopleurosis, and allows other diseases to flourish within the body. The two hormones normally identified with gender are estrogen and testosterone; however, there are several other hormones often overlooked prescribed to make gender reassignment as successful and manageable as possible.

As a patient treatment with the normal/correct level of each hormone, the positive results will be clearly visible with time. It is important to understand that hormone therapy will not change the sex of an individual (will not alter genitals), but is used to determine the secondary sexual characteristics expressed by the body. If patients identify themselves differently than their anatomically determined gender, it is common for them to seek hormone therapy in order to alter their physical appearance to become more like that gender and feel more comfortable in their body. Estrogens (female hormones) will affect the distribution of fat cells within the body (i.e. formation of breasts), widening of hips, loss of facial hair, but has little-to-no impact on the voice. On the other hand, androgens (male hormones) deepen the voice as the Adam’s Apple grows and stimulates facial and chest hair; however, such treatments often lead to male pattern baldness. These are just some basic examples of the impact hormones can have on the body, and should not be taken lightly. It is often said that hormone therapy gives transgenders the opportunity to look on the outside how they feel on the outside, and is safer and more affordable than undergoing SRS.

14. Costs and Coverage

In addition to physical and mental stress, sex reassignment surgery can be a burden financially. Before even considering the cost of surgery itself, patients have to evaluate all additional costs as well because most insurance companies do not cover or even help with payments related to SRS (i.e. air fare, hormone therapy, home care, psychotherapy, hospital stay, etc.). If undergoing surgery in order to change from a male to a female, the average cost of the surgery alone ranges from $7,000 - $24,000. On the other hand, when undergoing surgery to change from a female to a male, the surgery cost alone begins at $50,000, reaching as high as $100,000 for those who choose to undergo a series of operations rather than all at once. While undergoing SRS, most patients choose to undergo plastic surgery so their body will match their new identity. Surgeries such as breast augmentation (average cost: $3,708), hair transplants (average cost: $4,000-$15,000), and other appearance-altering procedures have the potential to increase the cost of the entire transition process dramatically.

Most transgender individuals are unable to undergo the operation due to these high costs, and chances are that your insurance will not help out at all. Originally considered an experimental, cosmetic, and elective surgery, insurances refused to pay for any medical expenses related to the gender change. As the medical field continues to grow and improve, some insurances now cover the procedure without any complications. In fact, resources such as CoveredCalifornia, ObamaCare, Medica, and some state health plans now Gender Reassignment surgery. For those who can’t even afford insurance, there are plenty of additional resources for those who desperately want to undergo the operation. For example, organizations such as the Jim Collins Foundation and GiveForward provide coverage or funding opportunities for qualified candidates desperate for the operation.

15. How to Be Supportive

At any level, gender dysphoria has the potential to create a challenging, overwhelming, and sometimes unbearable situation. When dealing with confusing thoughts about gender identity, it does not only affect the individual, but is incredibly challenging for those affected by it in any way. If one has never experienced thoughts even close to those of a transgender, it seems almost impossible to understand how someone could feel that they were born into the wrong body. Personal accounts have stated that without the approval and support of the people they love, they feel helplessly trapped inside their own body. More often than not, family members or close friends reject an individual for questioning their gender, a devastating circumstance that has led to the tragic suicides of many transgenders – “their only escape.” Even if you or someone you know are not going through an experience like this, you can always help those who are.

The best way to help those going through this tough time of self actualization is to educate yourself. Whether it is by books, researching medical cases, or reading personal accounts online, it is important to understand various sociocultural identity groups, appropriate behavior, and the significance that gender has in one’s life. With knowledge comes empathy, compassion, and support…all of which are lacking in today’s society. When asked the best way to help, the majority of those who responded (and identified as transgender) answered by asking people show respect by avoiding assumptions about sexual orientations, thoughts, or treatments someone is going through. Whether due to personal beliefs, religion, or lack of subject knowledge, accepting and understanding transgenders, SRS, gender dysphoria (or anything related), can be very difficult. If you are faced with difficulties such as this, medical professionals suggest to seek support of your own. If you are unsure about seeing a mental health professional, there are countless support groups for for family, friends, and significant others of transgender people. Whether you are the one undergoing this change or know someone who is, remember that you are not alone!